5 Things to Watch for With the OPPS Final Rule

Posted by Kathy Dean on 08/14/2017


FY18 OPPS Final Rule


1. Payment update

CMS proposed updating the OPPS rates by 1.75 percent.  A positive 2.9 percent market basket update, a negative 0.4 percentage point update for a productivity adjustment and a negative 0.75 percentage point adjustment for cuts under the ACA. Estimated hospital OPPS payment increase by 2 percent next year.


2. Proposed 340B program changes

CMS proposed paying hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B program. That's compared to the current payment rate of ASP + 6 percent.


3. Proposed update to inpatient-only list

The Medicare inpatient-only list includes procedures that are only paid for under the Hospital Inpatient Prospective Payment System. Each year, CMS reviews the list to determine whether any procedures should be taken off of the list. For 2018, CMS proposes removing total knee arthroplasty from the IPO list. 


4. Possible revisions to laboratory date of service policy

The changes would allow laboratories to bill Medicare directly for molecular pathology tests and advanced diagnostic laboratory tests excluded from the OPPS packaging policy and ordered less than two weeks following the date of a patient's discharge from the hospital. Under currently policy, if a test is ordered less than two weeks after a patient's discharge date, the hospital must bill Medicare for the test and then pay the reference lab that performed the test.


5. Hospital Outpatient Quality Reporting Program changes 

For 2018, CMS proposed to remove two measures from the Hospital Quality Reporting Program for the 2020 payment determination and subsequent years. The measures CMS is proposing to remove are:

  • OP-21: Median time to pain management for long bone fracture
  • OP-26: Hospital outpatient volume data on selected outpatient surgical procedures

For 2019, CMS proposed to remove four measures from the Hospital Quality Reporting Program for the 2021 payment determination and subsequent years. 

The measures CMS is proposing to remove are:

  • OP-1: Median time to fibrinolysis
  • OP-4: Aspirin at arrival
  • OP-20: Door to diagnostic evaluation by a qualified medical professional
  • OP-25: Safe surgery checklist use


Comment period

CMS will accept comments on the proposed rule until Sept. 11. 

CMS website